- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $5,248.07 / $18,620.87
| Facility | | $3,801.89 | $5,248.07 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,162.28 / $4,570.88
| Professional | | $2,137.96 | $3,162.28 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $6,456.54 / $8,912.51
| Facility | | $3,801.89 | $6,456.54 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $660.69 / $4,365.16
| Professional | | $602.56 | $660.69 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $3,630.78
| Facility | | $3,630.78 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $27,542.29
| Facility | | $2,344.23 | $2,344.23 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,630.78 / $3,630.78
| Facility | | $1,513.56 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,819.70 / $5,011.87
| Professional | | $1,513.56 | $1,819.70 | $5,011.87 |